Yoshino Kaori, Komasawa Nobuyasu, Mimhara Ryosuke, Sawai Toshiyuki, Minami Toshiaki
Masui. 2017 Feb;66(2):171-173.
Here we report successful anesthetic management of emergency thrombectomy for a patient with undiag- nosed polycythemia vera. A 67-year-old man com- plained of numbness of the right lower limb and was diagnosed with acute artery obstruction. Emergency thrombectomy was scheduled. Preoperative blood exam revealed hemoglobin 21.0 g · dl⁻¹ (hematocrit, 63.4%). During central venous catheter placement, we con- firmed high backflow blood viscosity; blood was diluted with plasma substitute. Hemoglobin was main- tained at 14-15 g · dl⁻¹ with continuous administration of plasma substitute. On re-perfusion of the right lower limb, potassium increased to 7.6 mEq · ml⁻¹, which responded to calcium carbonate, GI therapy, and furo- semide. Surgery was uneventful and the patient was diagnosed with polycythemia vera postoperatively. As perioperative management of polycythemia vera is challenging, particularly in undiagnosed and untreated cases, efforts should be made to avoid further throm- bosis and cardiac events.
在此，我们报告了一例未确诊真性红细胞增多症患者紧急血栓切除术的成功麻醉管理。一名67岁男性主诉右下肢麻木，被诊断为急性动脉阻塞，计划进行紧急血栓切除术。术前血液检查显示血红蛋白为21.0 g·dl⁻¹（血细胞比容为63.4%）。在放置中心静脉导管期间，我们确认回流血黏度高，遂用血浆代用品进行血液稀释。通过持续输注血浆代用品，将血红蛋白维持在14 - 15 g·dl⁻¹。右下肢再灌注时，血钾升至7.6 mEq·ml⁻¹，经碳酸钙、胃肠治疗及呋塞米处理后血钾恢复正常。手术过程顺利，患者术后被诊断为真性红细胞增多症。由于真性红细胞增多症的围手术期管理具有挑战性，尤其是在未确诊和未治疗的病例中，应努力避免进一步的血栓形成和心脏事件。
